Lumbar Spondylosis and its Homoeopathic Management

Dr. Ruchi Singh¹, Dr. Priyanka Naraniya² ,Dr. Anju Bishnoi³,Dr.Chirag Mishra⁴.
¹   Associate Professor, Dr. MPK Homoeopathic Medical College Hospital & Research Centre (Under Homoeopathy University), Saipura,  Sanganer , Jaipur. (Raj.)
 ^2,3 PG Scholar Department of Materia Medica, Dr. MPK Homoeopathic Medical College Hospital & Research Centre (Under Homoeopathy University), Saipura,  Sanganer , Jaipur. (Raj.)
⁴PG Scholar Department of Repertory, Dr. MPK Homoeopathic Medical College Hospital & Research Centre (Under Homoeopathy University), Saipura,  Sanganer , Jaipur. (Raj.)

KEY WORDS: Lumbar spondylosis, Degeneration, Intervertebral disc, Osteophytes, Homoeopathy.

INTRODUCTION: “Lumbar Spondylosis is degenerative condition characterized by narrowing of intervertebral disc & formation of abnormal bony growths known as osteophytes.  SPONDYLO is a Greek word meaning vertebra, LYSIS refers to degeneration.  It has been used synonymously with arthrosis, spondylitis, hypertrophic arthritis, and osteoarthritis.” It is especially common in young athletes younger than 18 years who participate in sports that involve twisting or backward bending motions of the spine. Spondylosis is an aging phenomenon. With age, the bones and ligaments in the spine wear, leading to bone spurs (osteoarthritis).Also, the intervertebral discs degenerate and weaken, which can lead to disc herniation and bulging discs. Physical activity & occupation involving twisting, lifting, bending, and whole body vibration (such as vehicular driving) are factors which increase both the likelihood and severity of spondylosis.  ^[1,2]

PROBLEM  STATEMENT: Spondylosis occurs in 6-10% of the general population and has been found to be as high as 25-60% in athletes.  In India -10.2% of women and  6.6% of men suffer from lumbar  spondylosis. The incidence and severity of low back pain were higher in women.^[3] In  UK adult population over age 50 years, 84% of men and 74% of women demonstrate at least one vertebral osteophyte, with increased incidence among individuals with more physical activity, self reported back pain, or higher BMI scores. That is men appear to have more significant degenerative changes than women^.[4]

PATHO-PHYSIOLOGY WITH CORRESPONDING CLINICAL SYMPTOMS:^{[1,2 ]}

Pathophysiology	Clinical features
Loss of hydration & elasticity of intervertebral disc with age	Low back pain
Bulging of annulus & overriding of facets	Tenderness of back
Hypertrophy of the facet joints & formation of osteophytes starts	Constant aching pain in back
Narrowing of cross-sectional area of vertebral canal	Stiffness
Compression of nerves	Numbness, burning, tingling & weakness
Due to further hypertrophy osteophytes developed	Restricted movements & scoliosis

Physical examination:

Following provocative tests for lumbar spondylosis plays a very important role in identifying the site of lesion:

1. Straight leg raising test-The patient is asked to lift the leg up with knee extended which causes pain at affected lumbo-sacral region.indiacting lesion at L5-S1 region.
2. Tripod Sign (L5-S1)- The tripod sign is conducted while the patient is in the seated position & elevating one of the legs, a positive sign will elicit pain, from L5 region, in the back and should be accompanied by the patient’s natural tendency to decrease the pain by leaning back and resting both arms on the table to support him or herself, thus the creating a tripod.
3. Femoral Stretch Test (L2-4)- With the patient in prone position, the leg is flexed at the knee while holding the base of the leg under the knee. Then the whole leg is lifted the up. If the patient complains of pain in the anterior thigh while the leg is lifted up, it indicates a positive test suggestlesion in the L2-4 region 

Diagnosis is based on X ray finding. CT and MRI help in an MRI of the lumbar spine shows the bones, disks, spinal cord, and the spaces between the vertebral bones where nerves pass through.

The Keele STarT Back Screening Tool (SBST) is a brief validated tool, designed to screen primary care patients with low back pain for prognostic indicators that are relevant to initial decision making.

GENERAL MANAGEMENT:

Exercise therapy (ET) remains one of the conservative mainstays of treatment for chronic lumbar spine pain, and may be tailored to include aerobic exercise, muscle strengthening, and stretching exercises. 

Lumbar back supports may provide benefit to patients suffering chronic LBP secondary to degenerative processes through several potential, debated mechanisms.  Supports are designed to limit spine motion, stabilize, correct deformity, and reduce mechanical forces. Van Tulder MW, Koes B, Malmivaara. Outcome of non-invasive treatment modalities on backpain: an evidence-based review. Eur Spine J. 2006;15(1):S64–81 

HOMOEOPATHIC  THERAPEUTICS:^[5]

• AESCULUS  HIPPOCASTANUM – Backache affecting sacrum and hips. Region of spine feels weak; back and legs give out. Worse walking or stooping and when walking feet turn under. Pain relieved by standing. 
• ALUMINA – Spinal degenerations and paralysis of lower limbs. Pain in the back as if a hot iron was thrust through lower vertebrae. Stitches, Gnawing pain, as if from hot iron.
• BRYONIA ALBA – When the pain and stiffness is worse on every motion and better by lying down and  complete  rest. Wants pressure or something hard under the back.
• CALCAREA  FLUORICUM – Chronic lumbago. Pain lower part of back, with burning extending  to the sacrum. Aggravated on beginning to move or rest, and ameliorated on continued motion.
• COBALTUM  METALLICUM – Pain in the back and sacrum. Worse while sitting and better by walking and lying.
• COLOCYNTHIS – Pain in the back and small of the back which finally  settles down on the upper part of the thigh and buttock. Cramp-like pain in hip; lies on affected side; pain from hip to knee.The neuralgic pains are nearly always relieved by pressure.
• EUPIONUM – Sacrum painfull, as if broken. Severe backache; must lean against something for support.
• GNAPHALIUM  POLYCEPHALUM – Lumbago with numbness in lower part of back and weight in pelvis. Worse from continued motion and  better resting especially on the back.
• GUAIACUM – Rheumatic stiffness of whole left side of back with intolrable pain on slightest motion or turning the part.  Not noticed on touch or during rest.
• KALIUM CARBONICUM – Lumbago with sudden sharp pains extending up and down back and to thighs. Stiffness and paralytic feeling in back. Nearly all better by motion. “Giving-out” sensation. 
• MEDORRHINUM –  Lumbago,  “ lame-back”. Legs heavy; ache all night; cannot keep them still. Pains intolerable, tensive, nerves quiver and tingle.
• PALLADIUM -Spasmodic pains. Dull pressing backache in afternoon, as from sitting too long in a stiff posture.
• RHUS TOXICODENDRON – Pain and stiffness in small of back, making rising difficult especially morning.  RheumaticTearing asunder pains.  Motion always “limbers up” the Rhus patient, worse, while sitting and hence he feels better for a time from a change of position.
• STAPHYSAGRIA – Lumbago compel patient to get up early feels better after rising. Pain in back as if broken, not allowing to stoop.

Previous researches on Lumbar spondylosis in homoeopathy:

• In a study entitled “Homeopathic Treatment of Lumbar Spondylosis: An Observational Study”^[6] reported a  mean improvement of 78% over baseline in VAS for pain. 
• In another study entitled “Physiotherapy and a Homeopathic Complex for Chronic Low Back Pain Due to Osteoarthritis: A Randomized, Controlled Pilot Study”^[7] suggested that homeopathic complex (containing 6CH each of Arnica montana, Bryonia alba, Causticum, Kalmia latifolia, Rhus toxicodendron, and Calcarea fluorica), together with physiotherapy, can improve symptoms associated with chronic low back pain due to OA significantly. 

REFERENCES:

1. Maheshwari  J.Essential orthopaedics,5^th ed.Sanat printers,kundli ,India,2015.
2. Clarke M,Kumar P.Clinical Medicine,Rehman A,Giles I. Rheumatic disease.9^th ed.elsevier Ltd.Netherland,2017.
3. Samal N, Deshpande SV, Singh P, Shrivastava S, Rathi R. Analysis of Incidence of Lumbar Spondylosis by Gender in Rural Area its Severity & Occupational Consequences: Rare Indian Study. The Journal of Maharashtra Orthopaedic Association. Oct-Dec 2013; 8(4):22-26
4. Middleton K, Fish E D. Lumbar spondylosis: clinical presentation and treatment approaches.NCBI 2009[cited 2018 nov 5];2(2): 94–104. Available from:http;//www.ncbi.nlm.nih.gov/pmc/articles/PMC2697338. 
5. Boericke W. New Manual Of Homoeopathic Materia Medica. New Delhi: B.Jain Publishers(P)Ltd; 2011.
6. Raj P, P, Babu, Bayula. Homeopathic Treatment of Lumbar Spondylosis: An Observational Study. American Journal of Homeopathic Medicine.  Autumn2015; 108( 3): 104-110, 7.
7. Morris M, Pellow J, Solomon EM, Tsele TT. Physiotherapy and a Homeopathic Complex for Chronic Low-back Pain Due to Oteoarthritis: A Randomized Controlled Pilot Study. Altern Ther Health Med. Jan-February 2016; 22(1): 48-56.